title: Delayed and overlooked diagnosis of an unusual opportunistic infection in a renal transplant recipient: visceral leishmaniasis.
abstract: Visceral leishmaniasis is a rare opportunistic infection in renal transplantation patients and its presentation may be associated with or masked by many other factors in immunosuppressed patients. So, if it is not searched for in particular, diagnosis may be easily overlooked or delayed in renal transplant patients. A 32-year-old renal transplant recipient devoleped splenomegaly, pyrexia and pancytopenia. Six months after the first bone marrow examination, the delayed diagnosis was made possible by a second bone marrow aspiration. Liposomal amphotericin B was effective in his treatment although he had a recurrence. Early diagnosis of visceral leishmaniasis is crucial for the renal transplant recipient's therapy; and even in treated patients, the mortality rate may be high. In our case, although the time up to diagnosis was as long as six months after the onset of symptoms, response to treatment was satisfactory with higher doses of liposomal amphotericin B in the second cycle. Also, in the short term, the rate of recurrence was comparable to other reported patients who were diagnosed and treated in a month.
authors.affiliation: Department of Nephrology, Adana Training and Research Center, Başkent University, Adana, Turkey. azumrutdal@yahoo.com
authors.forename: Ayşegül
authors.initials: A
authors.lastname: Zümrütdal
authors.forename: Ertuğrul
authors.initials: E
authors.lastname: Erken
authors.forename: Tuba
authors.initials: T
authors.lastname: Turunç
authors.forename: Şule
authors.initials: Ş
authors.lastname: Çolakoğlu
authors.forename: Yusuf Ziya
authors.initials: YZ
authors.lastname: Demıroğlu
authors.forename: Rüya
authors.initials: R
authors.lastname: Özelsancak
authors.forename: Soner
authors.initials: S
authors.lastname: Solmaz
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage; D000981:Antiprotozoal Agents / Q000008:administration & dosage; D001707:Biopsy, Needle; D001853:Bone Marrow / Q000469:parasitology; D057210:Delayed Diagnosis; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000188:drug therapy; D008081:Liposomes; D008297:Male; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000469:parasitology; D012008:Recurrence
chemical_list: D000981:Antiprotozoal Agents; D008081:Liposomes; D000666:Amphotericin B